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COMPLAINT/CONCERN REPORT FORM
Complaint / Concern Report Form
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W10=
Printable Version
Complaint Form
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Name
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Address
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Phone Number
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Describe Complaint/Concern and what occurred? Please be specific :
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I the undersigned, hereby attest that this report accurately describes what occurred to the best of my knowledge. I understand that any false statements made herein could result in criminal charges against me. (Please sign below)
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Report Completed By and Date
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Are you willing to testify in court if necessary?
Please Choose One
Yes
No
Monticello City Office Use Below
Report Reviewed by City Manager: Signature and Date
City Manager Recommendation/Action
Follow Up Information
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